Stevens-Johnson syndrome (SJS) is a rare medical condition with severe mucocutaneous reaction due to infection or adverse drug reaction. The present case reports the impact of chloroquine-induced SJS ...on the tooth root development. A 20-year-old Indian male reported to conservative dentistry and endodontics speciality clinic with the chief complaint of food lodgement and sensitivity in maxillary and mandibular posterior teeth. He had a past medical history of severe cutaneous reaction after taking Tab. Lariago (chloroquine) for treatment of malarial fever at the age of 8 years. The acute inflammatory immune response was managed by hospitalization and administration of steroids and anti-inflammatory drugs. Clinical examination revealed dry mucosa, carious teeth with adequate oral hygiene. Panoramic X-ray showed multiple teeth with short roots. A detailed cone beam computed tomographic scan (CBCT) demonstrated a healthy bone trabecular pattern with the absence of any periapical radiolucency. Short, blunt roots with immature apex were seen in many teeth. Based upon the measurement of root to the crown ratio on the CBCT scan and correlating the development status of teeth with the medical history, a diagnosis of short root anomaly (SRA) after chloroquine-induced SJS was made. This is the first report to describe the three-dimensional features of teeth with SRA in a patient with SJS. Diagnostic, restorative, and endodontic implications of SJS are highlighted.
Accumulating evidence suggests that somatic stem cells undergo mutagenic transformation into cancer initiating cells. The serous subtype of ovarian adenocarcinoma in humans has been hypothesized to ...arise from at least two possible classes of progenitor cells: the ovarian surface epithelia (OSE) and/or an as yet undefined class of progenitor cells residing in the distal end of the fallopian tube.
Comparative gene expression profiling analyses were carried out on OSE removed from the surface of normal human ovaries and ovarian cancer epithelial cells (CEPI) isolated by laser capture micro-dissection (LCM) from human serous papillary ovarian adenocarcinomas. The results of the gene expression analyses were randomly confirmed in paraffin embedded tissues from ovarian adenocarcinoma of serous subtype and non-neoplastic ovarian tissues using immunohistochemistry. Differentially expressed genes were analyzed using gene ontology, molecular pathway, and gene set enrichment analysis algorithms.
Consistent with multipotent capacity, genes in pathways previously associated with adult stem cell maintenance are highly expressed in ovarian surface epithelia and are not expressed or expressed at very low levels in serous ovarian adenocarcinoma. Among the over 2000 genes that are significantly differentially expressed, a number of pathways and novel pathway interactions are identified that may contribute to ovarian adenocarcinoma development.
Our results are consistent with the hypothesis that human ovarian surface epithelia are multipotent and capable of serving as the origin of ovarian adenocarcinoma. While our findings do not rule out the possibility that ovarian cancers may also arise from other sources, they are inconsistent with claims that ovarian surface epithelia cannot serve as the origin of ovarian cancer initiating cells.
Objective: The objective of this study was to determine the most suitable material for indirect pulp treatment (IPT) clinically and to determine the thickness (in mm) and type of tissue in terms of ...radiodensity (in Hounsfield units HU) formed after pulp capping using cone-beam computed tomography (CBCT) scan.
Materials and Methods: A longitudinal interventional single-blind randomized clinical trial was conducted on 94 children (7-12 years) with a deep carious lesion in one or more primary second molar and permanent first molar without the history of spontaneous pain indicated for indirect pulp capping (IPC) procedure. About 109 teeth were treated using three materials, namely, calcium hydroxide (setting type), glass ionomer cement (Type VII), and mineral trioxide aggregate randomly. The teeth were followed up at an interval of 8 weeks, 6 months, and 1 year for success of IPT as per the American Academy of Pediatric Dentistry clinical criteria. For determining the thickness and type of dentin tissue formed, a CBCT scan was done immediately postoperative and another scan at an interval of 6 months. The scans were compared to evaluate the average thickness of the dentin bridge formed.
Results and Conclusions: Success rate for IPC was 96.85%. A significant difference was obtained in the average thickness of reparative dentin at immediate postoperative and 6-month postoperative values in all three groups suggesting distinct barrier formation. Similar significant findings were obtained in radiodensity of barrier formed (in HU). All three materials were found to be equally suitable as IPC agents suggesting mineral gain.
Background: Pulpotomy is a vital pulp therapy performed in carious pulp exposures in teeth in which the inflamed coronal pulp is removed and medicament is placed to conserve the vital root pulps. ...Recently, simvastatin which is a cholesterol-lowering drug has been found to be associated with the pulp regenerative potential. Aim: The aim of this parallel two-arm randomized control trial was to evaluate and compare the clinical and radiographic efficacy of diode laser (DL) and simvastatin gel (SG) in pulpotomy of carious primary molars. Methods: Hundred primary molars (in 98 children, 65 males, 33 females with age 4-8 years) requiring pulpotomy were randomized into the DL or SG group. Pulpotomy was performed as per the standardized protocol; thereafter, all teeth were restored with resin modified glass ionomer cement followed by stainless steel crowns. Follow-up evaluations were done at 3 and 12 months using clinical and radiographic criteria. Statistical analysis was done using Chi-square test at a significance level of 0.05. Results: At 12 months, out of 92 teeth available for clinical and radiographic evaluation by blinded evaluators, DL group showed clinical and radiographic success rates of 76.1% and 52.1%, while SG group showed 80.4% and 65.2% success rates, respectively. There was no statistically significant difference between the efficacy of two techniques clinically (P = 0.49) or radiographically (P = 0.30). Conclusions: Both SG and DL had similar efficacy for primary tooth pulpotomy, clinically and radiographically after 12 months. Considering its ease of application and low-cost, SG can be recommended as a potential pulpotomy medicament in primary molars.
Endodontic therapy entails maneuvers in a complex anatomy. Intraoral periapical (IOPA) X-rays aid in providing information regarding the root canal system and periapical area. It offers clinicians ...with a high-resolution, low radiation, cost-effective imaging modality, and continues to be the method of choice for endodontic imaging. However, it has an inherent limitation of being a two-dimensional (2D) representation of a three-dimensional (3D) object. This can sometimes lead to misinterpretation, especially in cases where there is a diagnostic dilemma. Cone beam computed tomography (CBCT) has been specifically developed for the maxillofacial imaging. It has been extensively used for imaging during pre-, intra-, and post-endodontic therapy. It provides additional information when the sign/symptoms and the 2D radiographic picture do not collaborate. This paper highlights three interesting cases in which IOPA X-rays failed to divulge accurate information. CBCT aided the clinician to arrive at a correct diagnosis and treatment planning, thereby protecting the patient from further unnecessary iatrogenic complications.
Context: A wire composite splint (WCS) is most commonly used in clinical practice for the management of luxation dental injuries (LDIs). Wire thickness and adhesive point dimensions influence the ...rigidity of WCS. However, the influence of presplint tooth mobility on the rigidity of splint is not yet addressed.
Aim: The aim of this study is to identify the optimal thickness of WCS that achieves physiologic mobility in teeth with varying degrees of loosening (DoL) in a simulated LDI model.
Settings and Design: In vitro study.
Materials and Methods: Three typodont models with resin teeth were used. Right central incisor (Tooth 11) was simulated as an injured tooth and adjacent right lateral and left central incisor teeth (12 and21) acted as uninjured teeth. Each typodont model was modified to reproduce DoL 1, 2, and 3 in tooth 11 and categorized as Groups I, II, and III, respectively. The simulated injured tooth 11 was splinted with adjacent teeth 12 and 21 using 0.3, 0.5, and 0.8 mm WCS. Postsplinting DoL was assessed with Periotest.
Statistical Analysis Used: Two-way ANOVA and post hoc Tukey test were used for intragroup and intergroup comparisons of pre- and postsplinting Periotest values (PTVs). Friedman's two-way ANOVA and Kruskal-Wallis test were used for the intragroup and intergroup comparison of splint effect.
Results: Irrespective of the thickness of WCS, the postsplint PTVs corresponding to DoL 0 for simulated injured right central incisor tooth (11) were not achieved in Groups II and III. In three study groups, there was no statistically significant difference in the splint effect produced by 0.3 mm versus 0.5 mm WCS or 0.5 mm versus 0.8 mm WCS for tooth 11.
Conclusions: The postsplint DoL for a luxated tooth is affected by both the degree of presplint tooth mobility and the thickness of the wire.
Cone‐beam computed tomography scans exhibiting a second mesiobuccal (MB2) canal were examined. The vertical distance of the MB2 orifice from the pulp floor (depth), inter‐orifice distance (IOD) of ...MB2 from mesiobuccal (MB) and palatal (P) orifices, the horizontal distance of the MB2 orifice from the line joining MB‐P orifices mesial deviation (MD) and root canal configuration (RCC) were evaluated on 330 scans. The Student's t‐test, ANOVA, Spearman's correlation and linear regression analysis were applied. The MB2 depth was 1.69 ± 0.86 mm. IOD (MB‐MB2, MB2‐P) was 2.18 ± 0.58 mm and 4.63 ± 1.06 mm, respectively. MD was 1.02 ± 0.37 mm. The predominant RCC was Vertucci's type II (75.5%). No correlation of depth with IOD of MB‐MB2 (rho = 0.0367, p = 0.506) was observed. Significant correlation of depth with IOD of MB2‐P (rho = 0.696, p < 0.001) and MD (rho = 0.174, p = 0.001) was established. No association of depth with age and IOD (MB‐MB2) was observed on linear regression analysis. However, a significant positive association was established with IOD (MB2‐P) (p < 0.001) and MD (p = 0.001).
This position statement on Vital Pulp Therapy (VPT) procedures, endorsed by the Indian Endodontic Society (IES), aims to provide a comprehensive perspective on the management of deep caries and ...exposed pulp within the realm of endodontic practice. VPT serves as the cornerstone of modern endodontics, particularly with advancements in biomaterials and regenerative methods. Its primary goal is to preserve the vitality of the dental pulp while simultaneously promoting the overall health of the tooth and periapical structures. In the diverse and dynamic landscape of Indian dentistry, the IES recognizes the need for a position statement tailored to the unique needs and challenges encountered by dental practitioners in India. This position statement presents evidence-based recommendations on VPT, considering not only international perspectives from reputed international organizations, but also the distinct factors influencing dental care in India. Drawing upon the collective expertise of the expert committee, this statement addresses key aspects of VPT, including patient selection, accurate diagnosis, effective treatment techniques, and follow-up protocols. While conventional endodontic therapy remains important, IES emphasizes the significance of VPT in well-selected cases. The statement also addresses areas of potential conflict, identifies avenues for future research, and presents the current status based on the best available scientific evidence. By providing a comprehensive overview of VPT, this position statement aims to serve as a valuable guide for dental practitioners, educators, and researchers, fostering optimal patient care and advancing the field of endodontics in India through evidence-based practice and continuous learning.
Objectives
To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis.
...Materials and methods
The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (
n
= 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.5
0
C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer’s exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test.
Results
The cryotherapy group achieved haemostasis in less time (
p
< 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (
P
< 0.005). The overall success rate of pulpotomy after 12 months was 88% (
n
= 22) in both study groups(
p
< 0.05).
Conclusions
Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis.
Clinical relevance
The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.
Context: Coronavirus disease 2019 (COVID-19) is declared as a global pandemic by the WHO. Due to lack of proper vaccine, social distancing and restriction of movement in the form of"lockdown" have ...been implemented to curb the spread. This has crippled dental care in the country.
Aims: The aim of this article is to highlight the management of endodontic emergencies during the COVID-19 lockdown phase.
Settings and Design: Retrospective analysis of patient's data at a tertiary care center
Materials and Methods: The data of 247 patients referred to the specialty clinic between March 23 and May 31, 2020, were retrospectively analyzed. COVID-19 risk assessment was performed for all the patients. Based on the diagnosis, the cases were classified as emergency, urgent, or nonemergency. The endodontic intervention was performed for all the emergency cases. Minimally invasive dentistry and pharmacotherapy were provided for urgent and nonemergency cases.
Results: One hundred and seventeen patients presented with true endodontic emergencies (symptomatic irreversible pulpitis with or without apical periodontitis 80%, pulp necrosis and acute apical abscess 18% or traumatic dental injury 2%). About 82% of the emergency cases were managed by nonsurgical endodontic therapy, and vital pulp therapy was performed in 15.4% of the cases.
Conclusions: Management of most of the endodontic emergencies required the use of aerosol-generating procedures. Irreversible pulpitis was the most common cause for the patients seeking emergency endodontic treatment.
PDF
